Inspection on 28/10/08 for Agape House

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Agape House 29/05/09

Agape House 05/08/08

Agape House 12/02/08

Agape House 07/06/06

Agape House 15/05/06

Agape House 21/09/05

Agape House 15/04/05

Agape House 01/02/05

Extracts from inspection reports are licensed from CQC, this page was updated on 06/02/2009.

CARE HOMES FOR OLDER PEOPLE Agape House 45 Maidstone Road Chatham Kent ME4 6DG Lead Inspector Sue McGrath Unannounced Inspection 28th October 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Agape House Address 45 Maidstone Road Chatham Kent ME4 6DG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01634 841002 Mrs Nanthini Paramasivam Mr Thiyagarajah Paramasivam Manager post vacant Care Home 20 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 2. Dementia (DE). The maximum number of service users to be accommodated is 20. Date of last inspection 5th August 2008 Brief Description of the Service: Agape House is a detached Victorian home providing accommodation on two floors, there is a passenger lift to the first floor. Agape provides care for 20 older persons. It has four beds for service users with a diagnosis of dementia. There are a variety of aids and adaptations around the home, which enable more independence for the residents. The home has 16 bedrooms. The home is situated in a residential area less than a mile from Chatham railway station and town centre. The home is located on a main bus route and within walking distance of shops and a Post Office. The home has front and rear gardens with seating. The fees charged by the service range from £385 to £450 per week. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key Unannounced inspection that took place in accordance with the Inspecting for Better Lives (IBL) process. Key inspections are aimed at making sure that the individual services are meeting the standards and that the outcomes are promoting the best interests of the people living in the home. The IBL process for a Key inspection involves a pre-inspection assessment of service information obtained from a variety of sources including an annual selfassessment and surveys. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Further information can be found on the CSCI website with regards to the IBL process including information on KLORA’s and AQAA’s. Because of recent consistently poor outcomes for service users the focus of this inspection was on health and welfare of service users and the management of the home. The actual site visit to the service was carried out over two days by two inspectors. Time was spent touring the building, talking to people living in the home, talking to staff and reviewing a selection of assessments, service user plans, medication records, menus, staff files and other relevant documents. Five of the requirements made at the last inspection have not been met so Statutory Enforcement Pathways will be followed. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: Some of the residents spoken with said they felt well cared for and were happy in the home. All said they were given a choice at mealtimes although there was mixed reviews on the quality of the food. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 6 The home has three lounge areas, which residents said were comfortable and met their needs. Most residents said they liked their bedrooms and were allowed to bring in personal procession from home. Visitors said they could visit at any time and were always made welcomed. What has improved since the last inspection? What they could do better: The management of the home continues to be poor and this needs to be addressed urgently. A copy of the home business and financial plan must be forwarded to the Commission. A copy of certified accounts must also be forwarded to the Commission. Assessments need to be more robust and reflect the actual needs of any prospective service user. Care plans need to reflect the need of the individual and be accurate. They should be drawn up with the resident and or their representative and accurately reflect the assessments and give clear guidance to staff to ensure assessed needs are met. Reviews must be more accurate and reflect any changes in the condition of the service user. These processes should not be a paper exercise. The home needs to be cleaner and more domestic staff are required, including the week-ends. The home must have a robust cleaning schedule in place that is regularly monitored. The broken toilet must be replaced and the leaking bath repaired to reduce the risk of infections. The administration of medication must improve and be regularly audited. All paperwork relating to staff rotas etc must be kept on the premises. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Prospective residents are not given the full information on the home prior to admission. EVIDENCE: At the last inspection a requirement was made to update the statement of purpose and that the registered person should produce and make available to service users an up to date and accurate statement of purpose setting out the aims and objectives, philosophy of care, services and facilities and terms and conditions of the home. The Registered Provider confirmed this work had not been completed and therefore the requirement made at the last inspection has not been met and Statutory Enforcement Pathways will now be followed. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 10 With regards to the care for people with a diagnosis of dementia the statement of purpose is required to set out in specific detail the service and facilities to be offered and to demonstrate how the service offered will meet the needs of the individual service users with dementia. The service must demonstrate via the statement of purpose and proposed policies and procedures that the model of care to be adopted reflects best practise, which has been shown to produce positive outcomes for service users. The Registered Provider confirmed that the home had not admitted any new service users since the last inspection. However, the home assured the inspector a full assessment would be undertaken and that a joint assessment would be sought from Social Services if they funded the prospective service users. The owner also confirmed they had developed a new assessment procedure. This will be assessed in full at the next inspection. The requirement remains until it can be assessed as complied with. Prospective service users, particularly ones with a diagnosis of dementia, cannot be confident their assessed needs will be met. The home does not offer intermediate care. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. People who live in the home do not benefit from care plans that identify their current and changing needs and cannot be confident that their health care needs will be fully met. This has the potential to put them at risk. EVIDENCE: At previous inspections a requirement was made to ensure each resident had a service user plan of care generated from a comprehensive assessment (see Standard 3). This should be drawn up with each person and provide the basis for the care to be delivered. At the last inspection, the registered provider stated she had personally drawn up new care plans for each resident and that the standard had improved. We saw at that visit that this was not the case. At this visit, although we saw that there had been some improvements these were restricted to a few sections of a limited number of care plans. The Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 12 original problem of the care plans not reflecting the assessments and giving little guidance to staff as to how to meet the individual care needs remains. For example on 10 October 2008 a new care plan had been written for one person in order to support with their movement and handling needs. It stated that the person could weight bear but was restricted to a wheelchair and that staff should refer to the movement and handling assessment. We cross referenced the information in the movement and handling assessment and found that this was dated 23 June 2008 and stated that the person could not weight bear and a hoist should be used. This contradicted the information in the care plan and it was not possible to evidence how the registered provider was able to produce the new care plan. We asked the registered provider about this and she was not able to answer. There remains a generic approach to care planning that is not person centred and does not reflect individuality and diversity. Therefore this has contributed to people receiving a sub-standard level of care and support in their daily lives and this approach does not meet with either accepted good practice guidelines or National Minimum Standards. Person centred planning means discussing the needs of the individual and writing a plan specifically for that person. The care plan must reflect the needs and wishes of the individual. This is not happening. Examples of poor practice were seen in the records regarding the personal care offered to one service user in particular and the safeguarding vulnerable adults coordinator was informed. She arranged for the District Nurse to attend the service user. Care plans for the people with a diagnosis of dementia did not reflect a person focussed/centred approach and need to consider the impact of the process of dementia and the threat it poses to the individuals identity, their resulting behaviours and staff understanding of the persons fears and emotional reactions. None of the care plans had appropriate behavioural guidelines specifically for dementia clients. For example the monthly reviews for one person clearly identified that their condition had deteriorated and that they had become more confused and agitated. The care plan did not identify how to support this person and only stated that they had dementia. Although a high number of staff had completed dementia training, the management of the condition was poor with little or no understanding of the need to have robust and informative care planning in place for staff to follow. One service user with a diagnosis of dementia had left the building in May 2008 unattended and wandered along the busy main road outside. The home eventually found the resident via the Police in a private home several doors along the road. The Commission was not informed of the incident. There was no evidence on the care plan that a suitable risk assessment had been produced before or after the event. The key worker input sheet had identified Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 13 that the ‘ client’s whereabouts is to be known at all times as they may occasionally wander.’ One strategy used to manage the disruptive behaviour at nighttime for one service user with dementia was to put her in a strange bedroom with the door shut and the lights off. This could be considered as abusive. Clear notes were seen in the staff message book, which instructed staff not to put this resident in this room. The following night, however, staff wrote how they continued this practise. We can conclude from the management instruction that this was not the first time this had occurred. Staff spoken with were not always aware of the contents of some of the care plans and again this raises concerns that the care plans are not working documents. Daily notes were not reflective of any guidance, which had been placed in the care plans. For example, one care plan stated to encourage the person to go for short walks and elevate their legs. There was no indication in any of the records that this happened. On the morning of our visit we did not observe this practice. A requirement was made at previous inspections that the registered person must ensure each resident has a service user plan of care generated from a comprehensive assessment (see Standard 3) is drawn up with each service user and provides the basis for the care to be delivered. This has not been met and Statutory Enforcement Pathways will now be followed. Moving and handling assessment do not identify specific need or give clear instructions to staff. We spoke to 4 members of staff and asked how they supported one person with using the hoist. Staff gave different answers and the care plan and assessment did not give any clear guidance. Again a requirement was made at previous inspection regarding risk assessments and specifically manual handling assessments, this has not been met and Statutory Enforcement Pathways will now be followed. There was no evidence to support that people receive a full nutritional assessment, and in one file there was no assessment at all. The record also stated that the person had an ‘average BMI’ score. But there was no indication in the records to show how the registered provider had reached this conclusion. The provider stated she had a copy of a leaflet on how to use the of MUST (Malnutrition Universal Screening tool) but had not read it. Both the Provider and Deputy manager were due to attend training on the use of the MUST tool. Some weights were recorded in imperial and Waterlow assessments were in metric, this has the capacity to confuse staff. The requirement made at the last inspection has not been met and Statutory Enforcement Pathways will now be followed. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 14 Evidence was seen that service users have access to dentists, chiropodist and other health care professional as required. Records did not support that this was happening in a timely manner. For example, the last recorded chiropodist visit for one person was dated 24 January 2008. Staff were seen using wheelchairs without footrest. When asked about this they stated they could not find them. The condition of the wheelchairs in use was poor. The administration of medication was viewed and several errors were found. At the last inspection medication administration had improved and it was disappointing to see the standard falling again. Several errors were seen on the Mar sheets and because of poor recording it was difficult to ascertain whether the medication had been given but not signed for or just not given. The registered provider stated that previously she was auditing the medication on a regular basis but had stopped doing this. Most of the errors appeared to happen at teatime when the deputy manager was not on duty to administer the medication. A referral has been made to CSCI Pharmacy Inspectors. Most of the staff were seen to be respectful to the residents and to offer choices where possible. Comments from some visitors and observation on the day indicated that some staff did not give choices at all times and were forceful and sometimes domineering. The service user spoken with confirmed they were mainly happy in the home but some still said they got bored at times. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Little consideration is given to supporting people’s individuality or social preferences and staff choose the activities provided. EVIDENCE: Service users confirmed the daily routines remained fairly flexible and they felt happy with the level of activities on offer. Some said they were repetitive and they would like more variety. The registered provider stated she now employed a member of staff specifically for activities. When this member of staff was spoken with she confirmed she worked four hours doing activities one morning a week. Observation seen during the day confirmed service users were not asked if they wanted to do activities. The television was just turned off and sigma long music put on. Some service users appeared quite confused at this at first. The activities coordinator is advised to prepare a programme of activities that she has agreed with the service users in advance and that they have input into the type of activities offered. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 16 Other activities included an exercise session organised by a professional occupational therapist who came twice a month. Other activities also included music mornings and regular church services. The staff handover book indicated that the majority of service users were up and dressed by 6 am, which seems very early and could account for the fact that the majority of the service users were sleepy throughout the morning. Several staff members also confirmed this. This was discussed with the provider and the deputy manager who stated that this was not the case and that they have told staff not to get people up until they wanted to get up. The management must ensure that this instruction is adhered to and that staff reflect actual practise when writing their reports. None of the service users were sure of what time they had got up that morning. Service users confirmed that their relatives could visit whenever they liked and were always made very welcomed. Most service users said staff were very caring and they felt well looked after, however some said staff could sometimes be abrupt when they asked for assistance. This was also mention by a visitor to the home. During the inspection staff were mainly seen to be caring and considerate. The food and menus were not assessed at this inspection however it was noted that the full time cook had returned from maternity leave. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home are protected by policies and procedures for complaints and Safeguarding Adults, but some practices in the home put some residents at risk. EVIDENCE: The provider stated that the home ensures the residents are safeguarded from any abuse, neglect or harm by having a policy for the home as well as the Local Authority Guidelines. The provider stated that records were maintained of all verbal complaints. We looked at the complaints book and saw that there had been no recorded complaints since the last inspection. The provider confirmed there had been no complaints since the last inspection. In one set of daily notes it was seen that one family member had indeed made a complaint about a room being very cold and the bed not being made. This had not been recorded or acted upon. We discussed this and the Registered Provider was reminded of her responsibilities in making sure all complaints were listened to and acted upon. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some areas of the home need to be improved for the benefit of the people who live there. Maintenance and refurbishment work is reactive rather than proactive. EVIDENCE: At the start of the inspection it was seen that water was pouring though the ceiling of the blue lounge. The ceiling had large cracks in it and there was clear evidence of water stains on the walls indicating that this was not the first time there had been a leak. The leak was coming from a toilet in the en suite above. The Deputy Manager confirmed this toilet had been a problem in the past and that they had difficulties in getting it repaired, as it was a ‘saniflow type’. This Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 19 toilet must be replaced as soon as possible and the damage to the ceiling and walls repaired. It was also noted that a leak was coming from under the bath panel in the bathroom on the lower floor. The Deputy Manager confirmed the bathroom had not been used that day. All of the bedrooms were viewed and although some still remained dusty they were personalised and reasonably comfortable. In some rooms there remain concerns over issues such as missing wardrobe door handles and curtains hanging off the rails. The numbers of domestic hours had not been increased since the last inspection where these issues were highlighted. A member of staff informed the inspector that she had been asked to monitor the overall cleanliness of the home but had stopped this practice recently. The Registered Provider must ensure there is sufficient staff in place to ensure the home is clean at all times. It was also advised at the last inspection that a cleaning schedule be introduced and regularly monitored continuously. The home does not currently employ domestic staff at the week-ends and this needs to be addressed. The home has introduced a maintenance book that details repairs etc since the last inspection but there does not appear to be any system whereby the environment is closely monitored for cleanliness and general maintenance such as the issues highlighted above. This is a management issue. At the last inspection it was highlighted that the call bell system was not functioning correctly and a requirement was made that the registered person should ensure that a call system with an accessible alarm facility is provided in every room. Although the system has not been replaced there is now a monitoring system in place where all of the rooms are tested regularly to ensure the alarm system is working. The monitoring system must be maintained and this will be revisited at the next inspection. This requirement has been met. The bathroom highlighted in the last report was much cleaner. The Registered Provider confirmed they are now regularly checking water temperatures, but one member of staff stated that the water in the lower bathroom was often too cold and that they had to carry hot water from the kitchen. This was discussed with the provider who was unaware of the situation. This needs to be addressed. The broken keypad highlighted in the last report had been repaired and evidence was seen that all of the hoists were serviced and maintained. The registered provider had purchased a sluice disinfector but this had not been fitted and therefore was not in use as at the last inspection. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 20 The registered provider said there was a problem with the pipe work and this has caused the delay in fitting the apparatus. The proposed room would be in need of redecoration before it could be used as a sluice room. A requirement was made at the last inspection that the registered person shall having regard to the number and needs of the service users ensure that the premises to be used as the care home are of a sound construction and kept in a good state of repair externally and internally. This has not been met and Statutory Enforcement Pathways will now be followed. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who live in the home may be put at risk from poor guidance given to staff. EVIDENCE: The registered provider stated that she now considers she has sufficient senior staff on duty at week-ends and has changed the job description for senior care workers to include those who have sufficient experience. The provider must also change her statement of purpose to reflect this. We asked to see the previous four weeks rotas. The registered provider was unable to produce these. We asked that they were produced within 48 working hours. Regulation 17 and Schedule 4 clearly identify records, which should be maintained in the care home, and this includes a copy of the duty roster and whether the roster was actually worked. This is a management responsibility. Staff training was not assessed at this inspection but the provider did state that a training programme is ongoing and that she has booked four places for Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 22 senior staff to attend a ‘First aid at Work’ course that is due to start in late November. Staff training will be assessed in detail at the next inspection. Several staff confirmed they had completed an in depth dementia training course. Two staff files were viewed and were found to contain most of the information required under schedule two of the Care Standards Act 2001. There was some concern over one of the references supplied for one new staff member and the Registered Provider was advised to keep copies of all correspondence when appointing new staff. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not being managed efficiently and there is no leadership, guidance or direction to staff to ensure service users receive consistent quality care. EVIDENCE: The home is still without a Registered Manager and effectively is being managed on a daily basis by the Registered Provider, who had resigned as the Registered Manager in February 2008. The provider is advertising the post but not very proactively and is strongly advised to advertise in a more robust Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 24 manner. The home must have a manager who can be registered with the Commission. Throughout this inspection there was evidence of poor leadership skills and a lack of understanding of the needs of people with dementia and of the basics of care planning. Weak management means that staff do not always receive the guidance and support they should and this has an impact on the quality of care provided. People with a diagnosis are particularly at risk due to a lack of understanding of the basics for dementia care. The Registered Provider must ensure that robust monitoring on all aspect of the running of the home is promoted and maintained. We asked for a copy of the providers business and financial plan for the coming year and copies of the accounts and financial procedures to confirm current financial viability. These were not available in the home. We gave the provider 48 hours to produce these documents and returned to the home to collect them. Neither document was made available to us. Requirements have made to ensure these documents are produced. The registered provider confirmed that she does not hold monies on behalf of the residents and normally pays for the extras such as hairdressing, chiropody and newspapers etc and then invoices the families directly. The home now had an up to date fire risk assessment and the fire procedures had been updated. Standard 38 of the National Minimum Standards for Older People clearly state, “The health, safety and welfare of service users and staff are promoted and protected”. This includes the management of risks, accidents and incidents. We saw through the records that these were not being managed or risk assessed in line with the regulations or National Minimum Standards. The accident book recorded accidents in August, none in September and in October. The majority were from falls by service users. Records indicated that the provider did contact the falls advisor in August there were no records of any outcome on the relevant care plans. There was little supporting evidence of any action being taken to reduce further occurrences. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 25 The home is again requested to review its health and safety procedures and risk assessments to ensure that all elements of safety are inspected and maintained to ensure that the home meets with the required standards. Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 X X 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 2 1 x x x x 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 X x 3 x x 2 Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Timescale for action 30/11/08 2 OP21 23(2)(b) 3 4 OP27 OP34 17 Schedule 4 25(1)(3) 25 (1)-(4) The registered person must ensures that there is a policy and that staff adhere to the procedures for the receipt, recording, storage, handling administration and disposal of medicines, and service users are able to take responsibility for their own medication if they wish, within a risk management framework in that the administration of medication follows the guidelines from the Royal Pharmaceutical Society of Great Britain. The registered person must 31/12/08 ensure toilet, washing and bathing facilities are provided to meet the needs of service users that are in good working order in that the toilet above the blue lounge is replaced and the leak in the bathroom is repaired. The registered provider must 30/11/08 keep records of rotas worked in the home. The registered provider must 30/11/08 provide the Commission with the annual accounts of the care DS0000061836.V372555.R01.S.doc Version 5.2 Agape House Page 28 5 OP34 25(1) home certified by an accountant for the purpose of considering the financial viability of the care home. The registered provider must provide the Commission with a business and financial plan. 30/11/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Agape House DS0000061836.V372555.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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